[Texgreen] Deceit and Denial - a review published in Science

[David Pollard]

PUBLIC HEALTH:
Risks and Profits
A review by Charles E. Rosenberg*

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Deceit and Denial
The Deadly Politics of Industrial Pollution
Gerald Markowitz and David Rosner
University of California Press, Berkeley, and Milbank Memorial Fund, New
York, 2002. 428 pp. $34.95, =A324.95. ISBN 0-520-21749-7.
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The title says it all; Deceit and Denial does not promise neutrality.
History demonstrates that profit-driven corporate managers cannot be
trusted with our lives and health, Gerald Markowitz and David Rosner
claim. It is not only production workers that chemical manufacturers
often place at risk, but also all those men and women whose health might
be undermined by toxic substances in the environment. The authors are
prominent historians of public health and their thesis is forcefully
articulated and massively documented. They contend that without
preemptive governmental regulation strengthened by a concerned, alert,
and politically involved community we are all at the mercy of decisions
reflecting little more than short-term profit maximization. They are
muckrakers, but extraordinarily well-informed practitioners of that
traditional American art. And they have found a good deal of muck to
uncover. The book is structured around two extended case studies that
together span the 20th century. The first focuses on lead (in
particular, the white lead used in interior as well as exterior paints),
the second, on vinyl chloride. The story of lead covers the first half
of the century, that on plastic, the second. The authors weave a
narrative of continuity and change, change from a focus on occupational
health with a limited number of stakeholders and constrained role of
government to a far more complex world in which government and political
parties, lobbyists, media, and unions as well as scientists and
clinicians all play significant roles in shaping regulatory policy. A
key continuity is industry's control of information. Lead and vinyl
chloride, Markowitz and Rosner argue, are not atypical instances, in
which renegade industries have failed to be candid about known hazards.
"Lying and obfuscation were rampant in the tobacco, automobile,
asbestos, and nuclear power industries as well." Much of the book's
pivotal data became available only as a result of civil lawsuits against
lead and plastic manufacturers. The authors have had access to many
thousands of company and trade association documents that were
discovered by plaintiffs' lawyers who had contacted them in their
capacity as potential expert witnesses.

The story Markowitz and Rosner tell is highly circumstantial. In the
1920s, lead producers mounted a multidimensional defense of the use of
tetraethyl lead as an additive in gasoline. Organized around the Lead
Industries Association, producers fought off criticism that emerged
after a number of dramatic deaths among production workers. Their
tactics included funding a cadre of reliable researchers who produced
reassuring results--the most important of which allayed, for a half
century, fears of ubiquitous environmental effects from lead additives
in millions of automobiles. Even more dramatically, the authors devote a
grimly detailed chapter to the marketing of white lead in paint; the
substance continued to be advertised to paint contractors and consumers
for many years after it had become clear that it is particularly
dangerous to children. (Infants and toddlers who chewed on crib bars and
toys could be described as pathological, just as work-related ailments
could be blamed on worker carelessness or bad habits.)

Although lawsuits against lead paint manufacturers (or their successors)
still wend their way through the courts, in the second half of the book
Markowitz and Rosner shift their focus to plastics manufacture in the
last 40 years, when lead pigment paint had been largely banished from
the market (along with tetraethyl lead). They describe a vastly altered
regulatory environment. The Donora smog (which killed 20 residents of a
small Pennsylvania factory town in 1948), Rachel Carson and Ralph Nader,
diethylstilbestrol (DES) and thalidomide, Love Canal and, finally,
Bhopal had cumulatively made the public and media aware of environmental
contaminants. "Better living through chemistry" had evolved, in some
circles, from upbeat slogan to ironic commentary. In addition, argue
Markowitz and Rosner, the anti-authoritarianism of the 1960s created the
conditions for what might be called an environmental popular front.
Mainstream conservation groups (the Sierra Club, for example) joined
with unexpected allies such as labor unions and civil rights advocates
to support tough government regulation. Thus, it is not surprising that
the shrewd but hardly anti-business Richard Nixon signed the Coal Mine
Safety and Health Act (1969) as well as 1970 bills creating the
Occupational Safety and Health Administration and National Institute for
Occupational Safety and Health. Although enforcement remains subject to
the vagaries of politics, regulation has become a political reality--to
be supported or opposed depending on one's interests and attitudes.

It was in this new regulatory and political arena that, in the early
1970s, the Manufacturing Chemists' Association faced the dilemma of how
to deal with industry-commissioned research findings indicating that
vinyl chloride monomer could induce tumors in animals. These findings
and the clinical discovery of a cluster of rare angiosarcomas in vinyl
chloride workers confronted the Association with what was minimally a
public relations disaster. In an era of aggressive lawyers and
heightened sensitivity toward risk, the potential downside was enormous.
And, as the authors contend, it is not surprising that the information
was only slowly and grudgingly made public. The book makes a forceful
case against voluntary compliance as a realistic regulatory tool; it is
policy made plausible only by fears of civil liability.

The authors effectively dismiss voluntary compliance as an element in
any viable solution, but it is not clear that they provide a blueprint
for solving the human and policy dilemmas they describe so well. Is
there any way to refine some objective and thus policy-defining truth
from the process of its negotiation, dissemination, and social
articulation? What is permissible or calculated risk? The problem is not
only how one calculates such risk, but--the authors imply--who does the
calculating. They charge, for example, that under Reagan "the chief
criterion in standard setting was now industry's concern about the costs
of regulations rather than ascertaining the lowest feasible level that
would protect workers from toxic substances." But what does "feasible"
mean? Is it not another way of specifying the costs of regulation? And
does it not raise the specter of insoluble and incommensurate value
conflicts: What is the worth of one life? Or a life shortened by a
number of pain-filled years?

Or, as Deceit and Denial underlines, what of subclinical effects that
might include emotional changes and lowered cognitive ability? How are
such shadow effects to be monitored, judged, legitimated, meliorated?
And how does one balance such injury to particular individuals against
the effects of curtailing growth and inhibiting technological change? I
do not have an answer, and neither, I suspect, do Markowitz and
Rosner--or the economists, epidemiologists, and publicists who offer ad
hoc if seemingly authoritative solutions. Writing equations balancing
one risk against another is easy, at least as compared with reaching
political consensus in the confrontational real world of institutional
power and elusive perception.

All of which implies this book's strongest contribution, one implicit in
but going beyond the events it describes in such revealing detail. This
is the authors' emphasis on process and the way in which decision-making
is contingent, the end-product of negotiations always in progress, with
the actors changing over time. It is not only the actors who change, but
the
sets: Washington and state capitol committee rooms, management suites
and union halls, newsrooms and television stations, cyberspace, law
firms specializing in liability, and trade association conference rooms
are all sites at which portions of this contested negotiation have taken
and are taking place. And, as Deceit and Denial so powerfully
demonstrates through its very existence, even academic departments and
university presses contribute to what one must call a collective policy
discourse. The world Markowitz and Rosner describe is more like rugby
than econometrics.

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The author is in the Department of the History of Science, Harvard
University, Science Center 235, Cambridge, MA 02138, USA. E-mail:
rosenb3@fas.harvard.edu